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Thursday, March 30, 2017

It is the darkness of the situation that makes belief a necessary prerequisite of walking in.

A week ago, Scott landed in San Francisco to navigate his dad's failing health and his mom's anxious grief and his own weighty loss. The first few days carried little clarity. Confusing options, conflicting advice. Tomorrow, however, he will begin his journey back to our home in Kenya, with much peace. A lovely and reputable care facility with an opening for his dad; solid steps accomplished by his mom and him; hours upon hours of work and listening unfolding in progress.

A week ago, I was slogging through my first days back at work after our trip, the massive influx of patients who had waited through a more-than-three-month delay in care filling every bed at least double. One day I noted that the Newborn Unit number (39) and the Paeds ward (61) exactly added to 100. When you have a hundred patients being cared for by a team who resents return, who feels betrayed by the government and is talking of their next strike, who view medicine through demoralized eyes and dream of alternate careers, who come late and leave early so all work has to be compressed into a 3-5 hour day . . . well, you have to rush. You desperately try to find the impending disasters and stave off the nearest deaths. In the last 9 days we lost 9 patients: a 6-month old with Down Syndrome whose critical heart lesion had not been previously noted, a malnourished 3 year old who may have also harbored a malignancy, a 520 gram (1 pound) 24 week preem who tempted us to hope when she was perky and pink for two days, a 1.2 kg (2 1/2 pound) 28 week preem who looked desperately starved for air from day one but lulled us into thinking he would make it after ten days on CPAP (our bubble improvised oxygen delivery under pressure), an infant with croup who seemed to be responding to treatment and then was dead, a convulsing baby whose difficult birth left her brain damaged, a child with cerebral palsy who could not shake a severe pneumonia, a newborn with signs of a congenital infection causing heart and bleeding problems, and another baby the intern texted about because she didn't see why the nurses wanted to admit and next thing I heard the baby had died. Add to that pummeling of futility some serious push-back from resentful residents and the lingering potential that it could all implode again . . it was dark. Today, however, no one died. We had reasonable round with some good decisions and teaching; we found abscesses to drain, a culture-positive meningitis, x-rays most likely showing TB, new diagnoses of AIDS. The trainees joined me for chai and a talk on Down Syndrome. A taxi driver we've used texted me for help and I got to see his perfectly healthy just-delivered daughter. A nurse I respect took a photo to show me a nearly chubby (more than doubled in weight) return of a baby we had admitted a couple months ago. My pediatrician colleague, my sole Kenyan counterpart, returned from a training course that had immediately followed the strike, and with her diplomatic skill and equanimity ironed out a better schedule for our team to function.

For both of us, I think God was asking for us to believe, in spite of the darkness. Like the official in John 4 who had to take Jesus at his word about his son's distant healing, then went on his way home to be met by the news that the change occurred at the very hour of his ask to Jesus. (That story really struck me this week, as we ask for our children to be healed, protected, comforted, blessed from a very long ways away, and God gave me a glimpse that this is our story too).

The new moon is a falling tinsel sliver that dips into the sunset, leaving the nights dark right now. This is the Lenten season where darkness fills the horizon, the cross looms large, evil seems to sway. This is the season when we can only walk by believing.

Sunday, March 26, 2017

For those who are not on our email update (mailchimp) chain, Scott flew emergently to CA this week the day after we returned from Burundi, to be with his parents. The slow decline of previous strokes and dementia was punctuated by a new episode of bleeding in his dad's brain a few weeks prior. His mother had the house modified and hired a full-time helper in order to care for him at home, but after just over a week of trying this arrangement it was becoming abundantly clear that the situation was neither safe nor beneficial for either of them. Scott offered to come help; his mom jumped on the chance. In the 12 hours between reserving the ticket and arriving back in Kenya, Scott's dad landed back in the hospital with another arrhythmia episode. So Scott has been in Half Moon Bay since Thursday. We pray that over the course of the next week he and his mom can sort out a nearby nursing home or hospice-care facility. He's been setting up appointments to evaluate potential places, and working with the doctors to pare down the ballooning list of medicines his dad was put on, many of which he does not tolerate well.

We are grateful for the times that God has enabled us to be with our families in times of crisis. We know our parents pay a very, very high cost for the work that we do. We are more thankful than ever for the good visit we had in January; when Scott arrived this time, his dad did not recognize him. That is a painful milestone.

Many of you have similar stories, and even living in the USA it can be challenging to be working, supporting parents, supporting young adult children. This is a season of life, and we pray that by grace we can walk through it honoring those we love so much. Thanks.

Addendum: Check the two previous posts for Scott's excellent photos and some broad strokes on our recent trip to DRC, Uganda, and Burundi. And . . .
The paragraph below was in an email from Heidi L, a dear friend, and so meaningful I had to share it with you.

When I would talk to my South Sudanese friends about my mom and her deterioration, when they would ask how she was doing, after I would tell them, their response, that rang in my head and heart for the whole time she was sick and after she died, was “Rabuuna fi.” Literally translates to something like “Our Lord Is in”…”fi" can mean "is here" AND "is there” so it always was a kind of “I AM” statement for me…Our Lord Is. He is with you, He is with your dad, He is everything you need and everything your dad needs your mom needs Caleb needs Luke needs…He Is.

"There is a passage of the New Testament, namely the present one in John 9, which addresses this very issue," writes NT Wright in his commentary on the healing of the man who had been blind since birth. "Jesus' disciples are Jews. Yet they, and the Pharisees in verse 34, assume there is indeed a connection between present disability and previous sin. . . Thinking like this is a way of trying to hold on to a belief in God's justice. If something in the world seems 'unfair', but if you believe in a God who is both all-powerful, all-loving, and all-fair, one way of getting round the problem is to say that it only seems 'unfair', but actually isn't. There was after all some secret sin being punished. This is a comfortable sort of thing to believe if you happen to be well-off, well fed and healthy in body and mind. Jesus firmly resists any such analysis of how the world is ordered.The world is stranger than that, and darker than that, and the light of God's powerful loving justice shines more brightly than that. But to understand it all, we have to be prepared to dismantle some of our cherished assumptions and to let God remake them in a different way. We have to stop thinking of the world as a kind of moral slot-machine, where people put in a coin (a good act, say, or an evil one) and get out a particular result (a reward or a punishment). . . No: something much stranger, at once more mysterious and more hopeful, is going on . The chaos and misery of this present world is, it seems, the raw material out of which the loving, wise, and just God is making his new creation."

Amen.

Over the last two weeks, we saw some raw material of misery and chaos, where ethic groups had murdered each other and burnt down their communities. Where malaria ravages infants, where women routinely die for lack of a safe delivery option. Where university students are lucky to have access to one volume of a 50 year old text. Where teachers consider it normal to hit students with sticks for poor performance. Where an HIV-infected husband hands his newborn over to an orphanage after his wife's death, because he feels unable to cope with the five children they already had. Where a false Gospel of the cosmic slot-machine is used to deceive people.

But we also saw new-creation hope. Church leaders vowing, never again shall we let our region descend into hate. An agriculturalist with a passion for facilitating better gardens for women. Medical interns learning how to diagnose and treat the darkness. Young teams willing to live far from family, from conveniences like grocery stores or electricity lines, in order to be part of that bright light.

Sometimes travel in Africa is a bit like time travel. The place we visited in Eastern Congo felt like Bundibugyo of the 90's, while Bundibugyo now boasts paved roads and cell towers.

The visible glimpses of the new creation trajectory give witness to a deeper transformation we can only begin to see, by faith. The young grads who were once very green interns, now 30-ish team leaders with families of their own. The faithful teachers who have persevered over 17 years at CSB. In hearts and minds, we know justice is rolling down like a stream that broadens and gains momentum decade by decade.

Join us in praying for these pioneers, these partners. Ask God to complete the works of mystery and hope that bring the Kingdom to come. I'll close with two bonus photos of our adventurous crossing from Congo to Uganda on the Semiliki. Because sometimes pushing into the murky chaos and striving for light, is actually pretty fun.

Wednesday, March 22, 2017

There and back again, by budget sketchy jet, reliable MAF prop plane, canoe, 4WD truck, taxi, motorcycle, foot. From Kenya, to Uganda, to Congo, to Uganda, to Rwanda, to Burundi, to Kenya. The Area Director portion of our life got short shrift for over three months during the 100-day doctor strike, squeezing in emails near midnight, stepping away from the ward to make phone calls. But we left two weeks ago by faith to complete a planned visit to several of our teams and a potential new partnership in the DRC. We left with the promising hope that the strike was ending, but the doctors actually returned just before we did. It was agonizing to walk away, but we saw God's hand in the journey and believe it was the right decision. We returned with a great potential for a new team in a new place, with having witnessed some supernatural reconciliations, with a solid Memorandum of Understanding with one of our main partners, with hours of conversations and prayers and connections with people we love.

A handful of Scott's amazing photos can be sampled below; he has not yet downloaded most of them. But they will help illustrate a few summary points about Serge in East and Central Africa in 2017, what we do and why we go to those fraying edges to testify to God's grace.

Beauty

The land and the people, the rain pouring green into hills and rivers. We work in some spectacularly beautiful places, where creation has not been drastically altered by the exploitation of humans. The humans are there though, in force, the paradox of rural density, curious children popping out to accompany us, to greet, to observe. God made the thousand shades of green from banana stalks to cassava leaves, and the thousand shades of people with their unique reflections of the Trinity.

Binding the Fray

The unraveling of peace by the forces of evil takes many forms, so teams work holistically in diverse ways. Drying soy beans, corn, and sorghum to make a porridge to treat malnutrition (above). Using surgical skills to restore sight to the blind (below). Building wards. Translating the Bible. Teaching school. Piping clean water. Sitting with the sorrowful to pray. Celebrating weddings. And burials. Investing in church leaders. Living out the good news on the sports field. And on and on, threading grace through rough edges.

Projects and people

We love engineers. Because we know that the same roads, water, health care, schools that we all took for granted growing up are part of the way God's blessing flows. So sometimes we need the skills and tools and funds to put up a new 80-bed Paediatric ward, or create low-tech incubators. But most of our time and effort has been poured into people. When God wanted to rescue us, He sent His Son. At Serge we primarily send people to work and live and pray and sweat alongside those who are struggling. As we put our shoulders to the work together, as our lives intertwine, we are all transformed.

Leadership

As Area directors, we work most closely with the Team Leaders. So it is our joy and privilege to listen to them, to pray with them, to wrestle with difficult decisions and ask God for wisdom together, to share meals and family news. Serge now has 8 teams in 3 countries in East and Central Africa (plus South Sudan on hold because of war).

Partnership

We serve at the invitation of our national partners, and part of our job is to honor and maintain those relationships. In some places we work with a particular church, or a Christian university, or a coalition of churches for health work, or a local government. But we are always guests. This era of missions means we collaborate, we walk alongside, we listen to each other. While we don't hesitate to politely strive for what we believe is best, we have to keep pace with our hosts. You can pray for all of us in this regard. It is so easy for cultural chasms to divide us, for our own pride to trip us up.

Kids

When families relocate, kids get caught in the nebulous universe of the "third culture". They are not quite your average North Americans like their parents, but they are not fully embraced by the local culture either. Enter the MK teachers, who enable families to live in remote places but keep their kids on a grade-level-appropriate pace for eventual schooling in their country of origin. Concern for kids, their health, their sanity, their safety, their connection to extended family, their adjustment to the new language and culture, their traumas, their learning disabilities or speech delays, their friendships, their development . . . fills a big portion of our Area Director hearts. Ours looked like these two just a blink of an eye ago.

Saturday, March 04, 2017

After heart-wrenching gut-dropping soul-searching deliberation, we decided to go ahead with our planned Congo-Uganda-Burundi trip starting tomorrow. The chronic never-ending nature of this strike has made it very difficult to plan, and resulted in us falling far behind in our Serge Area Director job. We are physically weary, emotionally exhausted, and in desperate need of a break. Flying a small plane into Eastern Congo for days of intense cross-cultural meeting and vision setting isn't exactly a vacation, but we are moving forward trusting God's strength in our weakness. And trusting the sovereign timing of God's care to push a resolution to the strike. As of yesterday, the intervention of religious leaders (along with the Kenyan Law Society and the Kenyan Human Rights Committee, and the President) offered the first real glimmer of hope for compromise we've seen in a long time. Our visas miraculously came through on Thursday, Scott went to get them in our passports Friday, and we bought tickets last night. Today was another non-stop day of "our brand is crisis" and tomorrow we are off. Some photos I had on my phone from the last couple days below. Pray for our patients to be healed by the mercy of God as we go, and for us to be filled with wisdom and love for others as we listen and serve across three countries in two weeks.

Baby Hope, would you hope with me she would survive? Severe dehydration caused her kidneys to fail, but she may still recover. Pray for her.

The busy Newborn Unit, when you get 4 preems of about a thousand grams being transferred in one day . . and dozens of births per day . . .it gets crowded.

Preem corner, our two best incubators holding four babies who total up to weigh less than many American babies.

Jua Kali--Kenyan for "in the hot sun" which refers to the creative make-do engineering this country excels in. This, my friends, is an oxygen concentrator.

This mom finally went home with her very very premature baby, a triumph that took almost two months. The other moms took up a collection to get her some clothes to go home with, and bus fare. She was an 8th grade student (father was in high school). I love her smile, and resilience. And I love the way God's people are here in this place of need, moms helping each other.

My team. Grace works part-time while in school, but Zachariah is with me almost every day, and has proven himself to be thorough, compassionate, and reliable. I wouldn't have made it through the last two months without them, as things got much busier after December. This week they admitted an ICU-level critical baby without me one day when I had to leave briefly for a passport issue, and they did everything right. That made me so happy.

This brother brought his sister with AIDS back for follow-up as requested today . . since he's in school I saw them on a Saturday. She sadly also has TB, but we are hoping that treatment will extend her life.

One day I had these two admissions in rapid succession: 1120 grams on the left, 4135 on the right. Quite the contrast.

Maternity at Naivasha traditionally requires two patients to share each bed, it is so crowded.

Hoping to post from the road, but if it's not possible, don't forget to pray for us, and for those we leave behind.

Our Mission

who we are

paradox:
1. something that combines contradictory features or qualities.
Life in Africa is full of contradictions - the beauty and pain; the abundance and the poverty; the joy and the sorrow.
Our lives, too...dying that we might live; strong in our weakness; sinners yet saints.
2. a "pair of docs"